106 Diseases of the Genital Organs 



bendings of the cervical canal. The dilation of the cervical 

 canal is essentially alike for diagnosis and therapy. When 

 the canal is very narrow and is pressed upon by sclerotic en- 

 largements in the mucosa, the passage of a catheter suffi- 

 ciently large to permit of satisfactory douching either for 

 diagnosis or treatment, is both difficult and dangerous. Even 

 if it is accomplished, the cervical disease cannot be satisfac- 

 torily handled until the canal has been freely dilated. 



Once the instrument has reached the os uteri internum, 

 the gradual dilation of the canal should be undertaken by 

 forcing the forceps jaws apart with the thumb screw. The 

 opening of the jaws should be very gradual and prudence 

 used in the amount of force applied. In heifers especially 

 which have suffered severely from cervicitis, and there is 

 consequently well advanced sclerosis, the tissues may fail to 

 relax under the strain but rupture instead. The instrument 

 must on no account be pushed toward the uterus while the 

 jaws are opened as there is great danger of pushing them 

 through the uterine or cervical wall. There is great danger, 

 while dilation is proceeding, if the operator pushes toward 

 the uterus when the patient strains. At such times the in- 

 strument must be permitted to move backward with the cer- 

 vix. The process of dilation should be continued for a suffi- 

 cient period of time to render the cervical canal of sufficient 

 size to admit of the ready passage of a small uterine cathe- 

 ter, uterine dressing forceps, or other desired instruments. 

 Once the forceps blades are forced apart, the operator may 

 cautiously exert traction upon them, eventually drawing the 

 forceps out with the jaws widely separated. This presses 

 the free borders of the annular mucous folds outward 

 against the cervical walls and tends to cause them to remain 

 out of the way temporarily while the uterine catheter may 

 be introduced. It is best in case of a very narrow cervical 

 canal to open and close the dilator alternately and while 

 closed to revolve the instrument in varying degrees so that 

 the direct pressure of the blades shall be exerted on all parts 

 of the cervical walls. With patience, the pale muscles of the 

 cervix gradually become exhausted and finally the canal at- 



